ENDOCRINE - THE CHILD W AN ENDOCRINE OR METABOLIC...

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THE CHILD W/ AN ENDOCRINE OR METABOLIC ALTERATION : chap. 17 Birth history Height history of family members Pubertal history of parents Developmental milestones Height, weight, BSA, BMI Tanner stage of puberty- 5 of them: know* Mid-parental height versus target height Presence of dysmorphic features Family history of endocrine disorders History of brain tumors, trauma to head, chemotherapy or radiation to head and neck -GROWTH HORMONE DEFICIENCY (HYPOPITUITARISM) Clinical presentation Delayed growth (<2 inches/year) Consistent declination of height on growth chart Delayed puberty Infants born with hypoglycemia Delayed dentition Diagnostic testing Growth hormone stimulation testing Growth hormone peak levels IGF-1, thyroid panel, cortisol Bone age x-ray Karyotype Nursing interventions Growth hormone replacement therapy SQ injections daily Growth assessment every 3 to 4 months Patient education Medication administration Medication side effects Compliance with medications and follow-up visits - PHENYLKETONURIA (PKU ) Genetic metabolic disorder resulting in CNS damage from toxic levels of phenylalanine in the blood Routine screening performed in all 50 states at birth Test must be performed 24 hours after baby has had first feeding to ensure digestion/absorption Child must be 48 hours of age Restrict phenylalanine intake If untreated infant will have CNS damage by 3-4 weeks of life Cambrooke foods provides formula and supplements for all ages Avoid: High protein foods like meat, fish, eggs, cheese, milk, and legumes Avoid: any drinks/foods containing aspartame Eat: fruits, vegetables, starches Do: take phenylalanine free protein supplement Mental retardation
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Microcephaly- brain doesn’t grow like it’s supposed to Retarded growth Seizures ^ incidence of structural defects - CONGENITAL HYPOTHYROIDISM: -type of Dwarfism Congenital lack of thyroid hormone If left untreated can lead to mental retardation Occurs in 1 in 4000 births in the US T4 levels quickly drop after birth Mandatory testing in all 50 states before leaves hospital Skin mottling Large fontanel Large tongue Hypotonia- not a lot of muscle tone Slow reflexes Distended abdomen Enlarged tongue Prolonged jaundice Lethargy Poor feeder/constipation Umbilical hernia Cool to touch Hoarse cry Excessive sleeping Generalized edema Diagnostic Testing: T4, TSH, T3 Elevated TSH- thyroid stimulating hormone. If high then T4 will auto be low.
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